Trauma and the Brain

by Jan E. Estrellado, Ph.D.

image source: 

http://www.forbes.com/sites/toddessig/2015/12/02/post-traumatic-stress-disorder-ptsd-is-more-than-a-bad-story/#31ac76b313ad

Responses to trauma can be found in both the mind and the body.  In the mind, people can experience unwanted, intrusive thoughts that remind them of the traumatic event.  They may feel misunderstood, isolated, and irritated with others around them.  Their beliefs about the world might change from a sense of safety and stability to one of unpredictability and danger.

In the body, people can feel “on edge,” like something bad is about to happen.  They may feel more anxious than usual, with symptoms of an increased heart rate, sweatiness, hyperventilating, difficulty focusing, or even a panic attack.  This is more likely to be true when they are exposed to an internal or external cue reminding them of the traumatic event, but for others, it can feel like it comes out of nowhere.

Trauma Response in the Brain

For an individual with PTSD, much of the response to trauma can be found by understanding what is happening in the brain. 

When something might be dangerous or threatening, it first goes to the thalamus, which is responsible for receiving sensory input (what you see, smell, taste, touch, and hear).  From the thalamus, it can go in one of two directions.  In the first direction, the “more sensible” direction, the sensory cortex accurately appraises the event as non-threatening and the hippocampus (responsible for memories), confirms or modifies this response.  This direction, while slower than the second direction, is often more capable of accurately assessing true threat.

Image source: 

http://www.helpguide.org/articles/ptsd-trauma/ptsd-in-the-family.htm

In the second, “less sensible” direction, the thalamus sends signals to the amygdala (the emotion and fear center of the brain), which then goes to the hypothalamus, where action is taken to get relief.  This direction is often seen as tapping into the “fight or flight” response to fear.  While this direction is quicker and engages our survival mechanisms, it can also get us into trouble if our response is bigger than the situation calls for.

For individuals with PTSD, their brains often go in the second direction.  Their amygdala is on “over-drive” and cannot help them evaluate what is a true threat and what is not. 

Re-Training Your Brain

If your brain is trained to fire its amygdala at will, what can you do about it?  Enter the pre-frontal cortex.  This part of the brain is responsible for planning, strategizing, executing, reasoning, and decision-making.  At CSAM, we often encourage our patients with PTSD to engage their pre-frontal cortex in various ways: deep breathing, mindfulness practice, even coloring!  Any grounding activity that helps you stay in the present moment will help you engage your pre-frontal cortex.  These are effective short-term strategies for helping to manage an individual’s immediate PTSD-related anxiety.

Longer-term strategies include Cognitive Processing Therapy (CPT), Prolonged Exposure Therapy (PE), and Acceptance and Commitment Therapy (ACT).  These interventions have strong support in the scientific literature showing their effectiveness to manage PTSD.  In CPT and PE, patients “re-train their brains” to reduce their reactivity to distressing cues, often related to the traumatic event.  They continually re-write or re-tell the story of their traumatic event until they make new meaning of the trauma, learn that the trauma memories are not dangerous and discover that they can handle the upsetting responses that come with remembering the traumatic event.  In Acceptance and Commitment Therapy, patients practice mindfulness in order to understand what distressing thoughts they have when they recall the traumatic event.  They develop a willingness to engage with the memories and feelings of the traumatic event, so that they are “freed up” to live a life based on their values and what’s important to them.

CSAM is here to help

If you or someone you love might benefit from CPT, PE, or ACT following a traumatic experience, or if you would like more information about our other therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

References:

U.S. Department of Veteran Affairs (2015).  How common is PTSD?.  Retrieved from http://www.ptsd.va.gov/public/PTSD-overview/basics/how-common-is-ptsd.asp

When Kids Feel Different: Coping With the Stress of Not Fitting in by Embracing Individuality

a guest blog by Craig Pomranz (@MadebyRaffi), author of Made By Raffi, a children's picture book addressing the common issue of feeling feeling different

www.craigpomranz.com

Since writing my children's book about a little boy who likes to knit and sew, I have been thinking a lot about gender issues.  On one hand, our generation has shaped a more tolerant society, but has anyone else noticed that we are also seeing more pressure to conform?  I don’t particularly like the word tolerance.  It holds a negative idea for me.  Is it our discomfort or the fear of our children being teased and bullied?  I see even the moderate eccentricity that makes life interesting frowned on as parents seem to gravitate to pink princesses for girls and macho sports for boys.  With these mixed messages, no wonder our kids seem more self-conscious, and anxious. 

Image source: http://cincinnatichildrensblog.org/healthy-living/gender-variance-part-ii-acceptance/#.VqwTdVMrLeQ

How much misery and wasted talent is caused by the projection of these artificial ideas about what are appropriate activities for boys and girls?  Being considered a tomboy is not such a bad thing in our male-centered society, but if a boy participates in an activity that is considered "feminine," horrors!  And what about the terrible message we are sending to girls?  Why is feminine a negative idea?  Why is it that a girl wanting to engage in male activity is cheered on (or at least receives sympathy for trying), but if a boy wants to display what is perceived as “girl” behavior, he is put down.  The message:  why on earth would a boy want to emulate female behaviors?  The misogyny is depressing.

Add to that, with all the best intentions, we give our kids very little time on their own to explore, "try on" new identities that are all part of healthy growing up.  With all this close observation, they become self-conscious and more fearful.  How can we help a child manage in this world?  Can we help a child be comfortable enough in their own skin to be able to face the world and embrace their individuality, thereby reducing their stress?  How can we bridge these differences and rid ourselves of society’s stereotypes? It’s a complicated issue.

Now boys and girls exhibiting nontraditional behaviors seem to have a new thing to worry about -- do people think I am gay?  The fact that the LGBT community is more a part of the national conversation and has more acceptance is obviously a good thing, but it has become another thing to be self-conscious about.  In the past, it would not have been a worry because homosexuality wasn't even thought about regarding children.  Not that keeping that “secret” or question doesn’t have its own anxieties. 

Image source: http://tophdimg.com/summer-kids-playing.html

The solution?  Separate behavior from sexual identity. 

There is nothing inherently gay about yarn and knitting needles, of course.  A preference for listening to classical music over watching football doesn’t hint that a child is gay.  Even curiosity about what it would be like to dress as a member of the opposite sex reveals nothing other than, well, curiosity.  If these truths could be accepted among children and parents, stress would be reduced.

The “Like a Girl” campaign (linked here) demonstrates that children have to be taught gender behavior – it is not inherent.   The “Be a Man” link here https://youtu.be/KYvWhzSKoc4  shows the pressure we put on our children to behave in certain ways.  

Exploring many interests is the best way to find oneself and become a whole person.  I hope kids will discover that being a boy or girl is not a sharply defined role, but can encompass many activities. I hope parents will leave their kids alone and when they feel pressure don't panic and call in the National Guard (or the teacher), but teach children strategies to focus on their own exploration, ignore idle chatter, and above all remind them that they are loved unconditionally.  This is one way we can bring self-assuredness to children so as not to become victims. 

When my godson started knitting, his classmates could not understand why he was participating in a “girl’s hobby."  But undaunted he stuck with it, showed his serious interest in being creative and eventually his classmates came to appreciate him for his talent.  Those who once teased him look to him with respect.  When he “coined” the term TomGirl I immediately felt the need to write about it.  My humorous book based on the incident, Made by Raffi, seeks to both entertain and help children and adults become more comfortable with who they are in their own skin.  Thusly avoiding peer pressure and victimization.   

Anxiety and Chronic Illness

by Jan E. Estrellado, Ph.D.

Chronic illness affects half of all adults (117 million) in the United States (Center for Disease Control, 2012). These conditions can include chronic pain, fibromyalgia, arthritis, heart disease, HIV, and cancer. While the types of conditions vary broadly, stress and anxiety are common experiences for individuals with long-term illnesses.  

The Stress of Having a Chronic Illness

Image source: https://massage.elitecme.com/blog/chronic-illness-massage-therapy/

Anxiety may result in part from the unpredictable nature of a chronic illness.  For example, a person with chronic pain will likely have some days when he or she can go for long walks and some days when getting out of bed is too challenging.  The tough part is not knowing when the bad days come.  The anticipation and fear of the pain, even more than the pain itself, is a better predictor of long-term functioning  (Turk, 2002). 

Because the experience of a chronic condition is specific to each individual, it can be difficult to feel connected to others.  Isolation is common, which can both disrupt relationships and intensify negative thinking (“No one understands what I’m going through,” “I have to take care of this on my own,” “I don’t want to burden my family,” etc.).  When those negative thoughts start to spin out of control, especially without the support of others, one’s ability to manage anxiety lessens.

For a child with chronic illness, fear and anxiety can be especially common.  The unpredictability of a chronic illness can shape how he or she views the world as an adult.  Knowing that caregivers cannot control discomfort or pain may be particularly terrifying for a young person.  A child may internalize the uncertainty of what life will look like with a chronic illness (“Will I still be able to go school,” “What will my friends think,” “Will I have to take medications forever,” etc.).

Managing Anxiety Related to Chronic Illness

Each person chooses how to manage his or her chronic illness in the best way possible with the resources they have.  An important step in managing anxiety related to chronic illness is to ask one’s self about the benefits, as well as the costs, of those choices.  For example, someone with heart disease may feel that by eating whatever he wants, he is in control of his life and that his condition does not exist.  But the stress of feeling ashamed or of disappointing others also takes its toll.  Being open and honest with one’s self about the pros and cons of choices is a crucial step to managing stress.  When a person can have this conversation with one's self, he or she might be more willing to ask if this choice supports the type of person he or she want to be.

Image source: http://www.huffingtonpost.com/2011/06/30/chronic-pain-13-americans_n_887749.htm

Another way to help manage anxiety about a chronic condition is to be as present as possible, even when it is difficult.  Calling attention to your thoughts, feelings, and bodily sensations in a non-judgmental way is the practice of mindfulness.  This can be especially difficult when what you think, feel, or experience is intense pain or discomfort.  However, a review of research showed that mindfulness-based practices can improve patient outcomes not just for chronic illness management, but also for depression and anxiety (Grossman, Niemann, Schmidt, & Wallach, 2004). 

If you have a family member with chronic illness, your support is very important.  A research review on the relationship between family support and chronic illness found that patients responded most positively when their families emphasized self-reliance and personal achievement, family cohesion, and responding attentively to symptoms (Rosland, Heisler, & Piette, 2012).  Continuing to reach out to your family member with a long-term condition can make a huge difference in their management of their illness. 

Living with a chronic illness is by no means easy.  Living well with a chronic illness, however, is possible.  With the right support and coping skills, individuals with chronic conditions can take concrete steps on the path of living with, but not being ruled by, long-term illness. 

CSAM is here to help

If you or someone you love might benefit from acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), or biofeedback for anxiety, depression, stress, or a chronic medical illness, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

References:

Center for Disease Control (2012).  Chronic diseases: the leading causes of death and disability in the United States.  Retrieved from http://www.cdc.gov/chronicdisease/overview/.

Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004).  Mindfulness-based stress reduction and health benefits: a meta-analysis.  Journal of Psychosomatic Research 57(1): 35-43.

Rosland, A.M., Heisler, M., & Piette, J.D. (2012).   The impact of family behaviors and communication patterns on chronic illness outcomes: a systematic review.  Journal of Behavioral Medicine 35(2): 221-39.  doi: 10.1007/s10865-011-9354-4.

Turk, D.C. (2002).  A diathesis-stress model of chronic pain and disability following traumatic injury.  Pain Research & Management, 7(1): 9-20.

Pursuing Values over Resolutions in the New Year

by Jan E. Estrellado, Ph.D.

2016 has arrived!  As we say good-bye to 2015, it’s time to look forward to setting intentions for the new year.  Knowing that resolutions don’t always work out, what if we tried basing those intentions on our values rather than on our goals?

Image source: http://allisonpataki.com/set-new-years-resolutions-january/

The Problem with Resolutions

It seems that while many people make resolutions every year, only a few are able to maintain those changes.  According to the Statistic Brain Research Institute (2015), 45% of people in the U.S. make resolutions, but only 8% of people successfully achieve them.  In 2015, the top three resolutions for the new year were losing weight, getting organized, and spending less/saving more.

Why might it be so hard for us to accomplish the resolutions we set so hopefully at the beginning of each year?  And perhaps more importantly, how do we deal with and recover from the guilt, anxiety, stress, and embarrassment that often come when we fail to meet these goals?

For some helpful answers, we might look to Acceptance and Commitment Therapy (ACT), an evidence-based intervention that, in the words of Happiness Trap author Russ Harris (2008), “helps people create a rich and meaningful life, while effectively handling the pain and stress that life inevitably brings.” 

According to ACT (pronounced as one word), it is the struggle with “what’s wrong” in our lives that causes much of our suffering.  We’ve all been there: the slice of chocolate cake we couldn’t resist, the day we chose to stay home instead of going to the gym, or spending more than we wanted to eating out.  It is normal to feel ashamed, guilty, or frustrated with ourselves, often accompanied by thoughts of self-judgment and doubt (i.e., I have no self-control, I was doomed to fail from the start, etc.).  It is so easy to spend time and energy beating ourselves up for what we should have done, that we end up in a worse place than when we started.  How many of us have eaten that second slice of chocolate cake to soothe our guilt about eating the first one? 

Values-Based Living

Image source: http://www.sanitygurus.com/relaxation/

In contrast to resolutions, values are never finished.  Think of values as the direction you are headed in (“westward”) versus a destination west of you (“Hawai’i”).  One can continue on in that direction indefinitely and it will never be done.  It is a series of choices we make over and over again to carve out a path in the direction of that value. 

What might values-based living look like as an alternative to New Year’s resolutions?  Let’s take the #1 resolution of 2015: losing weight.  Why might losing weight be important to you? Do you want to feel good in your body, to invest in your physical health, to live longer for your family or to model healthy behaviors to your children?  Clarifying why we choose a goal might be more important than the goal itself.  For example, if I want to live long enough to see my kids grow up, my choices might focus more on being active with my kids and less on counting calories.  I may or may not lose weight, but keeping my choices and behaviors aligned with my greater value moves me toward the person I would like to be.

Acting in service of our values does not mean that the path will be easy or comfortable.  In fact, choosing our values means that we also choose the pain that will inevitably come.  Living from our values means we accept that painful and unwanted outcomes sometimes happen. Staying the values-based course as the painful stuff happens is what gives us meaning and purpose.

Are you willing to give values a try this year?

CSAM is here to help

If you or someone you love might benefit from acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), or biofeedback for anxiety, depression, stress, or a chronic medical illness, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

References:

Statistics Brain Research Institute (2015).  New years resolution statistics.  Retrieved from http://www.statisticbrain.com/new-years-resolution-statistics/

Harris, R. (2008).  What is acceptance and commitment therapy?  Retrieved from   http://www.thehappinesstrap.com/about_act

Travel-Related Anxiety

Image source: http://www.oncallinternational.com/blog/holiday-air-travel-survival-guide/

Many people travel during the holiday season to visit friends and family.  For those struggling with anxiety, traveling by personal car, airplane, bus or train, can be triggering and stressful.  The expectation to visit loved ones living afar can cause pressure and conflict within relationships and families when someone feels they cannot travel.

Types of Travel Phobias

According to the U.S. Department of Transportation (2001), 91% of holiday travel is via personal car.  Car-related fears can stem from either being the passenger or from being the driver (Neuman, 2012).  Anxious passengers may feel like they are not in control, while anxious drivers may feel like they may lose control of their vehicles due to panic attack or an accident (Neuman, 2012).   Fear of having a panic attack while driving is a common concern.  People cope with these fears by limiting how far they drive, how often they are in the car, and by only being in the driver’s (or passenger’s) seat.  This can have a debilitating effect on one’s ability to work, socialize, and get outside the house. 

The fear of flying can come in various forms, including fear of having a panic attack while on a plane, fear of crashing, and claustrophobia (Seif, n.d.).  There are multiple aspects of flying that might trigger anxiety, including long lines at the airport, being far away from home, extended waits on the runway, or turbulence (Seif, n.d.). 

People who have difficulty riding on trains or on buses often have fears that they will be involved in an accident, that they will have a panic attacks while on the bus or train, or that they will feel trapped and unable to escape or get help. 

Treatment of Travel Phobias

Image source: http://www.in.gov/dva/2973.ht

Travel-related phobias can be successfully treated using exposure therapy.  Exposure therapy is an evidence-based treatment, meaning it has strong support within the scientific research literature showing the effectiveness of the treatment to manage these types of anxiety.  Exposure therapy is a type of cognitive behavioral therapy that includes the repetitive practice of engaging with the feared or triggering situation, within the safety of the therapeutic environment and with the guidance of a trained mental health professional.  

Social Anxiety

For people with social anxiety, traveling during the holidays can be doubly hard.  Traveling often means having to interact with others, especially if going by plane, train, or bus.  In addition, the pressure of socializing with others after arriving at your destination can be daunting. 

The treatment for social anxiety often includes exposure therapy.  Individuals receiving exposure therapy practice being in their feared social situations.  The goals in exposure therapy for social anxiety are to develop skills to manage uncomfortable and stressful feelings and to act in accordance with their desired social goals.

CSAM is here to help

CSAM can help you or someone you love by providing exposure therapy for travel-related and/or social anxiety, cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), or biofeedback.  CSAM also helps treat other conditions related to anxiety, depression, stress, or a chronic medical illness.  If you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

References:

Neuman, F.N. (2012).  Driving Phobia: An Ideal Treatment.  https://www.psychologytoday.com/blog/fighting-fear/201207/driving-phobia-ideal-treatment

Seif, M.N. (n.d.).  How can I overcome my fear of flying?  http://www.adaa.org/living-with-anxiety/ask-and-learn/ask-expert/how-can-i-overcome-my-fear-of-flying

U.S. Department of Transportation (2001).  U.S. Holiday Travel.  http://www.rita.dot.gov/bts/sites/rita.dot.gov.bts/files/publications/america_on_the_go/us_holiday_travel/html/table_01.html